Source: Cancer Resource Room

What is Head and Neck Cancer?
Head and Neck Cancer is a cancer in any part of the head or neck (except in the brain or eye). These cancers can start in the nose, sinuses, mouth, tongue, tonsils, or throat. Most head and neck cancers are squamous cell cancers. Like all cancers, head and neck cancers are abnormal cells that grow and multiply without stopping. They form a lump (or mass) and the cells from that spot can spread to lymph nodes and other parts of the body. Head and neck cancers have symptoms that help people find these cancers early. The symptoms are noticed by the patient during a regular check-up with the dentist or doctor. The sooner a head and neck cancer is found, the more likely it is to be cured.

What are the symptoms of head and neck cancer?
Early symptoms are:

• A sore or swelling in the mouth (on tongue, under the tongue, inside the cheeks, along the gums, on the roof of the mouth)
• Sore throat that doesn’t get better
• A change in the voice, especially hoarseness that doesn’t come with a cold
• Numbness or tenderness of the face.
• Blood in saliva (spit) or phlegm (fluid)
• Swallowing problems
• Ear ache, pain in or around the ear, especially when swallowing, or a change in hearing.
• Lump in the neck, a lump that lasts for more than 2 weeks and/or gets larger. This may be a lymph node to which cancer has spread.

Any of these symptoms can occur with ordinary colds, infections, dental problems, or other illnesses. But if the symptoms seem unusual or last more than about two weeks, you should see your doctor.

How is head and neck cancer diagnosed?
Cancer of the head and neck is diagnosed by physical exam, X-rays, a biopsy, and talking with the patient about any symptoms he/she may have. Asking about any other health or dental problems past or present, including personal habits such as smoking or drinking is important in making this diagnosis. A complete physical exam, with a careful look at the mouth, throat, nose and neck should be done. Part of the physical exam usually requires an endoscopy. Endoscopy is looking far into the back of the mouth or deep in the throat using a flexible tube that has a miniature camera in it. This is done under general anesthesia in the operating room. An endoscope can look all the way down the esophagus and lungs, and if any abnormal lumps or swellings are felt, or a spot of flesh that does not look normal is seen, a piece of that tissue is snipped out. The tissue is looked at under a microscope. The sample is called a biopsy, and the specialist who looks at it is a pathologist. The pathologist looks at the cells of the biopsy tissue to see if they are cancerous, and if the cancer is there, what type of cancer it is. Other tests that can help make the diagnosis are X-Rays, CT scans (displays X-Ray “slices” of the area being viewed), and MRI scans (shows pictures of different tissues using a magnet and computer system). These images or pictures can show where abnormal lumps or masses are located. CT and MRI scans can show swollen lymph nodes where cancer may have spread and areas where cancer may have invaded nearby tissues.
It is the combination of medical information from the patient, the physical exam, the imagery studies, and the biopsy that leads to the diagnosis.

Other tests:
When a head and neck cancer is diagnosed, the question of whether or not it has spread needs to be answered. The CT scan or MRI of the head and neck can show spread to lymph nodes because they will be enlarged. A CXR scan is done to see if the cancer has spread to the lungs. An ultrasound or CT scan of the liver can show cancer spread there. Blood tests are used to evaluate a person’s general health. For example, anemia (a low red blood cell count) often occurs in people who are seriously ill. There are no specific blood tests for head and neck cancer.

What types of cancer occur in the head and neck?
Most are called squamous cell cancer (carcinoma). Squamous cells are cells that line spaces or cover surfaces of the body. Most cancers of the head and neck occur in the tissues that line the spaces of the nose, sinuses, mouth, and throat, so they are usually squamous cell cancers. Other cancers that develop in the head and neck are lymphoma (immune system cancer), adenocarcoma (cancer of a gland, in this case salivary gland that makes “spit”), and sarcoma (cancer of muscle, bone, cartilage, nerve, or blood vessels). Squamous cell cancer is the type that occurs about 85% of the time.

Useful definitions (word meanings):
Nasal: having to do with the nose.
Cavity: a space
Sinus: a space or tunnel connected to the nose. Sinuses help warm and moisten (humidify) the air we breathe, filter out the dust and dirt, produce mucous.
Pharynx: a space at the back of the nose and mouth, and upper part of the throat.
Glottis: the open area between the vocal cords.
Larynx: part of the pharynx containing the vocal cords.

What does “stage” mean?
The stage of a cancer tells how far a patient’s cancer has spread. As the stage number goes up, the cancer becomes more involved, and it is harder to cure. The stage of disease is divided into three categories, T, N, and M.

• T for tumor – How much normal tissue tumor has gone into. A number follows the letter, and the higher the number, the deeper the cancer has invaded.
• N for nodes – Spread of cancer to lymph nodes. The number after the letter goes up with the size of the biggest node and whether or not nodes are enlarged on one or both sides of the node.
• M for metastasis – Spread of tumor beyond lymph nodes to other parts of body.

An “X” after T, N, or M means the number cannot be determined because the information is not available. “Tis” means carcinoma in situ (also Cis), the earliest stage of a developing cancer. It means the abnormal cancer cells are only in the first layer of lining cells. They do not go any deeper in the tissue. This is also called Stage 0.

The stage of a cancer is used in choosing the right treatment for each patient. Lower stage diseases may need only limited surgery to remove it. Higher stage diseases may need more involved surgery as well as radiation treatments or chemotherapy. Stage is matched with the outlook for cure and survival as well. This is called prognosis. The lower the stage, the better the outlook for survival.

In general stage I and II head and neck cancers differ only in the size of the tumor. Stage I has the smaller size tumor and stage II has the larger size tumor. Stage I and II have not spread, they are N-0 and M-0. Stage III is confusing because it contains information about tumor size and spread. The tumor size can be larger than stage I and II and no spread to lymph nodes (T-3, N-0). Stage III can be a smaller tumor than would be stage I or II, and has spread to lymph nodes (T-1, N-1 or T-2, N-1). So stage III is a bigger tumor with no spread to nodes or a smaller tumor with spread to nodes. Stage III tumors have not spread to other parts of the body. Stage IV cancers have spread to lymph nodes and other parts of the body from any size tumor. The exception to this staging is in oral cavity (inside the mouth) and orophayngeal (back of mouth and upper throat) cancer. In these areas stage III can be a large (T-3) tumor but no nodes (N-0) or metastases (M-0), or stage III can be a small tumor (T-1) with spread to lymph nodes on one side of the neck (N-1) but no metastases (M-0).

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